Received Date: Aug 21, / Accepted Date: Oct 04, / Published Date: Oct 84 patients referred their primary problem was axial pain (facets/discs) and 68 In proper selected cases, the uses of interspinous spacers and endoscopic . processes and restrict extension to reduce pain in patients with lumbar spinal ( Spacers). Last Review Date: 07/ Page 2 of 6. Spacer (ISS) and the coflex. the nerves. Interlaminar spacers are implanted midline between adjacent lamina and spinous processes or an interspinous U. These implants aim to restrict painful motion while otherwise enabling normal motion. .. Effective date 10/2/06 .
About Dynamic Stabilisation With an Interspinous Spacer
Concerning the other 6 patients, one is waiting for endoprosthesis replacement, one died as a result of the baseline disease, and the remaining 4 did not accept to be submitted to a new surgical procedure at risk of perpetuating the infectious process. These patients remained with the spacers, and no major complication was found so far. Of the 7 seven patients submitted to spacer insertion, 6 six evolved with shortening of the affected limb, which ranged from 1.
Taking only the patients who survived throughout follow-up into account, we have a cure rate of Due to the small sample, we couldn't design an appropriate multifactorial analysis to determine which variables present a stronger impact for peri-endoprosthetic infection treatment. Such high incidence occurs mainly because of oncologic patients' characteristics, which, many times, have diseases leading to immunosupression.
Furthermore, chemotherapy and radiotherapy play an immunosuppressant role both local and systemicincreasing the risks of infection. On the other hand, tumor resection surgeries requiring reconstruction with NCE are major procedures, showing a lengthy surgical time and leading to a higher risk of infections. Since the 's, many authors have tried to determine which would be the best method for peri-prosthetic infection treatment.
The first treatment method described for treating infections in knee total arthroplasties was the plain surgical cleaning, recommended to any type of infection around implant materials.
Use of antibiotic spacers for knee endoprosthesis infections treatment
In their series of 45 patients, 40 presented infection as the root cause of implant failure, being submitted to knee arthrodesis. With this technique, they were able to achieve a faster union and less shortening compared to internal techniques. Insall14 was the first author to write a review article about the peri-prosthetic infections theme. The author considered surgical cleaning as imperative, as well as the implant removal and endovenous antibiotic therapy. Insall was also the first to suggest the review in two steps.
After the surgery, the patient would be on endovenous antibiotic therapy for six weeks, and only after that period a new surgery for inserting the new prosthesis would be indicated. In their text, the authors discuss that the pathologies leading to immunosuppression are the key risk factor for infection around knee total arthroplasty, followed by patients with previous review procedures.
Bliss and McBride16 emphasized, at the time, the importance of the full prosthesis coverage with myocutaneous flaps. In the 's, Borden and Gearen17 suggested a treatment protocol for knee total peri-prosthesis infection. The methods described by the authors consisted of primary review of the prosthesis, aggressive and isolated surgical cleaning, and of the review in two steps. Wilde and Ruth18 pioneered the description of a review method in two steps with the use of an acrylic cement spacer with antibiotics.
In that initial study, the authors removed the prosthesis and kept the patient under endovenous antibiotic therapy for 4. More recently, Gosheger et al. Since literature does not describe which would be the best method for treating deep infections around nonconventional knee endoprostheses, we found support on treatment techniques for infections around knee total arthroplasties.
Our primary concern was maintaining a conservative surgery on the limb. The indication of surgical cleaning previously to the endoprosthesis removal is described, which can lead to resolution of the infectious process without requiring a more aggressive procedure. However, we conclude that the method employed shows good results with great chances of curing the infectious process.
We also conclude that the major complication resulting from the method is dysmetria of the affected limb. Total femur and knee replacement using a metallic prosthesis. Clin Orthop Relat Res. Etiology and results of tumor endoprosthesis revision surgery in 64 patients.
Long-term results of limb salvage with the Fabroni custom made endoprosthesis. Prosthetic knee replacement after resection of a malignant tumor of the distal part of the femur: Medium to long-term results. J Bone Joint Surg Am. Acta Chir Orthop Traumatol Cech. Periprosthetic infection in pacients treated for an orthopedic oncological condition.
Arthrodesis after total knee replacement considering septic loosening as example. Two stage revision of infected uncemented lower extremity tumor endoprostheses J Arthroplasty. Disc herniation black discs, axial pain, radicular pain, foraminal pain and extraforaminal stenosis Lumbar interspinous process space: Candidates for both procedures was included. Surgical technique Patients were placed in prone position, under mild sedation and local anesthesia.
Transforaminal endoscopic discectomy was performed on the affected level, using endoscopes from 2. Percutaneous cylindrical interspinous spacer portal is recommended at 16 cm from midline and endoscopic transforaminal discectomy from cm.
For higher levels, always check the height of the kidneys and the retroperitoneal space. In case of working spaces like L3-L4 and L4-L5 at the same time, the entry point in L4-L5 can be used to be further away from the retroperitoneum. Access to the interspinous space can be achieved through the same portal.
When the dilatators are used as described in each technique for percutaneous cylindrical spacers, the muscle mass is depressed to achieve the other side horizontally. After the discectomy was performed, the soft tissue decompression i. If necessary, bone foraminoplasty was performed. After we finished the decompression, using the same portal access a guide was placed under fluoroscopic control in the interspinous space, progressive dilatators were used from 8 mm to 14 mm as needed in every case Figure 3.
The patient had neurological claudication on the right side and sometimes paresthesia on left L5 nerve.
Treatment Option for Spinal Stenosis - Interspinous Spacer
C Endoscopic foraminoplasty in the same patient shows a complete decompression of the thecal sac and transit L5 root. We used local anesthesia or epidural block depending on the how much pain the patient referred before the surgery.
The epidural catheter was placed after the discography, but the blockage was made minutes before we finished the endoscopic decompression. Patients with facet syndrome also received facet joint anti-inflammatory injections. All patients received a foraminal block after the decompression. Follow up and analysis We collected data retrospectively for VAS lumbar and radicular pain, Oswestry Disability Index, age, sex, diagnosisworked levels and procedure performed.
The data was collected for preoperatory status, 1 month, 6 months and 24 months. Also, the general satisfaction of the patient at 2 years.
Results Of the patients that had the minimum 2 years follow up, we lost 10 patients at the end. Another 7 had another surgery. Average age was 49 years old, 80 males and 72 females. A total of lumbar interspinous spacers were used. Significant decrease in pain. VAS lumbar pain dropped from 7. The preoperatory ODI was Patients reports significant improvement in their quality of life. We had 14 complications related to decompression and the interspinous spacer, 7 required revision surgeries.